Vocal cord paralysis as the presenting symptom of sarcoidosis

Abstract

A non-smoking 64-year-old man presented with progressive hoarseness which had developed over the previous 6 months. More recently, he noted weight loss, low grade fever and mild dysphagia. Past medical history was negative for tuberculosis, smoking, malignancy, neck trauma and for thyroid or pulmonary disease. He had difficulty in swallowing solid food but not fluids and had lost 13 kg in body weight over the last 4 months. His body temperature fluctuated between 37 ~ and 38~ He denied night sweats, pruritus or abdominal pain. Physical examination was unremarkable except for temperature of 378~ Ausculation of the chest was normal. There was no lymphadenopathy, hepatosplenomegaly or skin changes. Neurological examination was normal. Indirect laryngoscopy revealed paralysis of the left vocal cord. Slit lamp examination revealed no ocular pathology. Blood count, serum electrolytes, calcium and liver function tests were normal. A PPD skin test (10 units of Tuberculin) produced a response of 10mm. Angiotensin converting enzyme levels were normal on two occasions. Erythrocyte sedimentation rate was 15 mm during the first hour. Pulmonary function tests revealed normal expiratory flow rates, normal lung volumes and carbon monoxide diffusion